Journal article
Intermediate-risk Non-muscle-invasive Bladder Cancer:Recommendations for Definitions, Risk Stratification, Management Strategies, and Clinical Trial Design from the International Bladder Cancer Group
European urology oncology, Vol.8(6), pp.1685-1695
12/2025
DOI: 10.1016/j.euo.2025.08.003
PMID: 41076366
Abstract
BACKGROUND AND OBJECTIVE: Intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC) is a heterogeneous disease, and standardized definitions and risk-guided management are critical for appropriate patient care and clinical trial development. METHODS: A global committee of bladder cancer experts developed IR-NMIBC recommendations. Working groups reviewed literature and drafted recommendations, which were voted on by International Bladder Cancer Group (IBCG) members using a modified Delphi process. During an August 2024 meeting, voting results and evidence were presented, and recommendations were refined. Final recommendations achieved >75% agreement. KEY FINDINGS AND LIMITATIONS: The IBCG recommends inclusion of only low-grade (LG; G1 and G2) tumors in the IR-NMIBC category, risk stratified using the IBCG IR-NMIBC risk scoring system. Given the relatively indolent course and treatment burden of IR-NMIBC, therapeutic deintensification with active surveillance or office-based ablation is appropriate for select patients. Morbidity related to transurethral resection of a bladder tumor can be mitigated by forgoing restaging resection in completely resected LG tumors and not mandating muscularis propria sampling. Perioperative chemotherapy reduces recurrences, and additional adjuvant intravesical treatment should be risk stratified. Clinical trials evaluating novel IR-NMIBC therapies, including adjuvant and ablative designs, should incorporate patient-reported outcomes and risk-stratified controls. Ablative trials, as proof-of-concept studies for efficacy, require randomized controlled studies in the adjuvant setting to confirm superiority over the standard of care. CONCLUSIONS AND CLINICAL IMPLICATIONS: The IBCG consensus recommendations provide practical guidance for clinical care and clinical trial design for patients with IR-NMIBC.
Details
- Title: Subtitle
- Intermediate-risk Non-muscle-invasive Bladder Cancer:Recommendations for Definitions, Risk Stratification, Management Strategies, and Clinical Trial Design from the International Bladder Cancer Group
- Creators
- Roger Li - Moffitt Cancer CenterPatrick J Hensley - University of KentuckyMarko Babjuk - Charles UniversityLaura Bukavina - Cleveland ClinicSarah P Psutka - Fred Hutch Cancer CenterSeth P Lerner - Baylor College of MedicineMichael A O'Donnell - University of IowaYair Lotan - The University of Texas Southwestern Medical CenterKelly K Bree - The University of Texas MD Anderson Cancer CenterJoan Palou Redorta - Puigvert FoundationDavid J McConkey - Johns Hopkins HospitalByron H Lee - The University of Texas MD Anderson Cancer CenterParamananthan Mariappan - Western General HospitalLaura S Mertens - The Netherlands Cancer InstituteMark S Soloway - Memorial Regional HospitalRobert S Svatek - The University of Texas Health Science Center at San AntonioWei Shen Tan - Yale UniversityStephen B Williams - The University of Texas Medical Branch at GalvestonShilpa Gupta - Cleveland ClinicRoger Buckley - North York General HospitalAshish M Kamat - The University of Texas MD Anderson Cancer Center
- Resource Type
- Journal article
- Publication Details
- European urology oncology, Vol.8(6), pp.1685-1695
- DOI
- 10.1016/j.euo.2025.08.003
- PMID
- 41076366
- NLM abbreviation
- Eur Urol Oncol
- ISSN
- 2588-9311
- eISSN
- 2588-9311
- Publisher
- Elsevier
- Grant note
New York City, NY, USA) , Dr. Jeffrey S. Ross (Foundation Medicine, Albany, NY, USA) , Dr. Raj Satkunasivam (Houston Methodist Hospital, Houston, TX, USA) , Dr. Bogdana Schmidt (University of Utah, Salt Lake City, UT, USA) , Dr. Shomik Sengupta (Monash University, Melbourne, Australia) , Dr. Arlene O. Siefker-Radtke (MD Anderson Cancer Center, Houston, TX, USA) , Dr. Philippe E. Spiess (Moffitt Cancer Center, University of South Florida Morsani College of Medicine, Tampa, FL, USA) , Dr. Gary D. Steinberg (Rush University Medical Center, Chicago, IL, USA) , Dr. Arnulf Stenzl (Eberhard-Karls University, Tuebingen, Germany) , Dr. Rikiya Taoka (Kagawa University, Kagawa, Japan) , and Dr. John A. Taylor III (University of Kansas Medical Center, Kansas City, KS, USA) . We acknowledge the following bladder cancer patient advocates for their participation and valued feedback on the consensus recommendations: Rick Bangs (Bladder Cancer Advocacy Network) , Stephanie Chisolm (Bladder Cancer Advocacy Network) , Alex Filicevas (World Bladder Cancer Patient Coalition) , Lydia Makaroff (World Bladder Cancer Patient Coalition) , and Patricia Rios (Bladder Cancer Advocacy Network) . We also thank Prem Parameswaran Kumar and Allison L. Whitty for their support in the preparation and implementation of the IBCG consensus meeting, and Allison L. Whitty for her editorial assistance in the preparation and submission of the manuscript.
- Language
- English
- Electronic publication date
- 10/10/2025
- Date published
- 12/2025
- Academic Unit
- Urology
- Record Identifier
- 9985121500502771
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